Risk, shame and the public injector: A qualitative study of drug injecting in South Wales

Rhodes, Tim; Watts, Louise; Davies, Sarah R.; Martin, Anthea; Smith, Josie; Clark, David; Craine, Noel; Lyons, Marion

doi:10.1016/j.socscimed.2007.03.033

Cited by 149 publications

(121 citation statements)

References 48 publications

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“…62,63 Recent qualitative research in the United Kingdom shows how particular injecting environments can act as contextual amplifiers of stigma and shame, thus feeding risk rather than its avoidance. 23 Relations between stigma and HIV risks may be circular, with greater levels of stigma driving higher risk behaviors and/or lower access to prevention and treatment services among IDU subgroups, contributing to their further marginalization and vulnerability to other exogenous influences (eg, homelessness, arrest, incarceration). This "vicious circle" has been documented among IDUs of Dai ethnicity in China, a highly stigmatized subgroup that is overrepresented among HIV cases.…”

Section: Discussionmentioning

confidence: 99%

“…In such environments, HIV risk behaviors are shaped by the interplay of structural constraints placed on the availability of HIV prevention materials or the capacity of IDUs to enact risk reduction and what can be termed spatial practices arising from placed-based behavioral routines, norms, and risk perceptions. 23 Homelessness and unstable housing have been associated with a greater risk of HIV infection, [24][25][26][27] perhaps because homeless IDUs have closer engagement with street-based cultures of drug use and transactional sex and are more likely to experience situational disruptions in protective behaviors. 28 In contrast, stable living arrangements have been associated with higher rates of entry into drug abuse treatment.…”

mentioning

confidence: 99%

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Individual, Social, and Environmental Influences Associated With HIV Infection Among Injection Drug Users in Tijuana, Mexico

Strathdee

Lozada²,

Pollini

et al. 2008

JAIDS Journal of Acquired Immune Deficiency Syndromes

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144

179

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Objective-We examined correlates of HIV infection among injection drug users (IDUs) in Tijuana, Mexico, a city bordering the United States, which is situated on major migration and drug trafficking routes.Methods-IDUs aged ≥18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and structured interviews. Weighted logistic regression identified correlates of HIV infection.Results-Of 1056 IDUs, the median age was 37 years, 86% were male, and 76% were migrants. HIV prevalence was higher in female participants than in male participants (8% vs. 3%; P = 0.01). Most IDUs testing HIV-positive were previously unaware of their serostatus (93%). IDUs reported injecting with a median of 2 people in the prior 6 months and had been arrested for having injection stigmata (ie, "track-marks") a median of 3 times. Factors independently associated with HIV infection were being female, syphilis titers consistent with active infection, larger numbers of recent injection partners, living in Tijuana for a shorter duration, and being arrested for having track-marks.Conclusions-Individual, social, and environmental factors were independently associated with HIV infection among IDUs in Tijuana. These findings suggest the need to intervene not solely on individual risk behaviors but on social processes that drive these behaviors, including problematic policing practices. Policing practices may have a significant impact on IDUs' ability to adhere to safe injection practices, thereby influencing their risk of acquiring HIV. Qualitative evidence shows that local policing practices influence how, where, and under what circumstances IDUs obtain and use injection equipment. 28,[30][31][32][33][34] Disruptions to IDUs' risk reduction practices and engagement in HIV risk behavior have been linked to high-visibility policing and fear of arrest or detainment, 30 which exacerbates withdrawal symptoms. Quantitative studies report that aggressive policing practices are associated with higher levels of needle sharing [35][36][37][38] and lower utilization of syringe exchange programs (SEPs). 39,40 In an ecologic study of the macrolegal environment in 89 metropolitan areas in the United States, Friedman and colleagues 41 showed that higher levels of legal repressiveness were positively associated with HIV prevalence among IDUs. Studies are lacking to determine how such effects interplay alongside individual and social network factors. KeywordsMobility is emerging as an important risk factor in the transmission dynamics of communicable diseases, including HIV. [42][43][44][45] Migration and mobility are associated with family separation, disintegration of social networks, sudden changes in the cultural environment, homelessness, poverty, social isolation, and a greater sense of anonymity, which may enable riskier behaviors. [46][47][48][49][50] In one study, social pressures, including legal problems, entering drug treatment, and the It is legal to purchase or carry syringes without ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Individual, Social, and Environmental Influences Associated With HIV Infection Among Injection Drug Users in Tijuana, Mexico

Strathdee

Lozada²,

Pollini

et al. 2008

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

144

179

View full text Add to dashboard Cite

show abstract

“…Notwithstanding some recent research on the social identity of marginalised and disadvantaged drug users (Malins, Fitzgerald, & Threadgold, 2006;Rhodes et al, 2007), research on the management of stigma associated with drug use has primarily focused on controlled and recreational, middle-class users who tend to avoid statutory drug treatment services and 'recover naturally' from, or 'mature out' of drug use. In contrast to studies of middle-class controlled users, in our cohort only one of the 53 disengaged drug users interviewed had had a professional career and only four had received post-16 education.…”

mentioning

confidence: 99%

Are drug treatment services only for ‘thieving junkie scumbags’? Drug users and the management of stigmatised identities

Radcliffe

Stevens

2008

Social Science & Medicine

240

201

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a b s t r a c tThis article uses qualitative interviews with 53 problematic drug users who had dropped out of treatment in England, UK to explore how they describe the stigmatisation of drug users and drug services. It discusses the construction of the category of the junkie through its association with un-controlled heroin use and criminality. It shows how some drug users carefully manage information about their discreditable identities by excluding themselves from this category, while acknowledging its validity for other drug users. The junkie identity was generally seen as shameful and therefore to be avoided, although it holds attractions for some drug users. For many of the interviewees, entry to treatment risked exposing their own activities as shaming, as they saw treatment as being a place that was populated by junkies and where it becomes more difficult to manage discreditable information. The treatment regime, e.g. the routine of supervised consumption of methadone, was itself seen by some as stigmatising and was also seen as hindering progress to the desired 'normal' life of conventional employment. Participation in the community of users of both drugs and drug services was perceived as potentially damaging to the prospects of recovery. This emphasises the importance of social capital, including links to people and opportunities outside the drug market. It also highlights the danger that using the criminal justice system to concentrate prolific offenders in treatment may have the perverse effects of excluding other people who have drug problems and of prolonging the performance of the junkie identity within treatment services. It is concluded that treatment agencies should address these issues, including through the provision of more drug services in mainstream settings, in order to ensure that drug services are not seen to be suitable only for one particularly stigmatised category of drug user.

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“…While the fear of lacking drugs may serve as social glue, it may also act as a social dissolvent. Parkin (2013, p. 123) describes how drug injectors avoided other members in the drug scene in order to keep from losing drugs and/or money "by either volitional, reciprocal, forced or predatory means", illustrating that drug scenes can be fertile grounds for violence, antagonism, exploitation, mistrust, anxiety, and solitude (see also Agar, 1973;Briggs, 2012;Moore, 2004a;Rhodes et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…In this respect, togetherness on the street is produced by situational exigencies and a lack of alternative support mechanisms (Friedman et al, 1998a). Rhodes et al (2007) show how drug injection on the street is a result of constraints (e.g. homelessness) and urgent needs (e.g.…”

Section: Introductionmentioning

confidence: 99%

Group solidarity in a hostile milieu: Immigrant experiences in a street-based drug scene

Sandøy¹

2014

Drugs: Education, Prevention and Policy

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Based Drug SceneAims: Street-based drug scenes are typically portrayed as lacking in solidarity. Studies frequently cast camaraderie as solely instrumental, highly conditional, and temporary. The aim of this paper is to explore social dynamics and group solidarity in a seemingly hostile drug scene, and demonstrate the importance of this milieu for a group of immigrant men.Methods: Data was drawn from ethnographic fieldwork in the street-based drug scene in the downtown parts of Oslo, Norway. The fieldwork included participant observation, informal conversations, and 17 interviews with street-based drug users.Findings: Drug transactions, viewed as interaction rituals, may help create group solidarity among the members of the scene. Group solidarity is displayed in social bonds that drew former members back to the scene and in the inclusion of isolated, immigrant men. Conclusions:The street-based drug scene in Oslo, with its repeated interaction rituals and bonds of group membership, provides a community for people who experience low degrees of solidarity elsewhere, as demonstrated in the case of immigrants. This paper encourages a continued and improved emphasis on contexts for drug use as socially enabling environments.

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Risk, shame and the public injector: A qualitative study of drug injecting in South Wales

Cited by 149 publications

References 48 publications

Individual, Social, and Environmental Influences Associated With HIV Infection Among Injection Drug Users in Tijuana, Mexico

Individual, Social, and Environmental Influences Associated With HIV Infection Among Injection Drug Users in Tijuana, Mexico

Are drug treatment services only for ‘thieving junkie scumbags’? Drug users and the management of stigmatised identities

Group solidarity in a hostile milieu: Immigrant experiences in a street-based drug scene

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